Home Books Fitzpatrick's Dermatology in General Medicine, 8e

Chapter 212. Occupational Noneczematous Skin Diseases Due to Biologic, Physical, and Chemical Agents: Introduction

Paul X. Benedetto; James S. Taylor; Apra Sood

Occupational Skin Diseases Due to Biologic, Physical, and Chemical Agents at a Glance

Certain occupations are associated with an increased risk of infection (viral, bacterial, fungal, parasitic), arthropod bites and stings, or infestations.
Mechanical trauma is common in the workplace and can have skin manifestations.
Preexisting skin conditions may be aggravated by work-related mechanical trauma.
Occupational skin granulomas can be immunogenic (e.g., beryllium induced) or nonimmunogenic (e.g., silica induced).
Occupational skin diseases can result from excessive heat, cold, and other atmospheric factors such as low humidity in the workplace.
Exposure to silica, vinyl chloride, and other chemical agents can cause systemic sclerosis and limited scleroderma-like disease.
Occupational chloracne is one of the most sensitive indicators of toxic exposure to halogenated aromatic hydrocarbons such as dioxins and PCBs.
Occupational skin cancers due to exposure to chemical carcinogens or to ultraviolet light are a major health concern.

Noneczematous skin diseases caused by biologic, physical, and chemical agents in the workplace are discussed in this chapter. Trauma-related eczema is also included. For epidemiology, incidence, and management of occupational skin diseases, refer to Chapter 211.

Workers in healthcare, food services, cleaning and maintenance, and outdoor occupations are at a risk of developing skin infections. Table 212-1 lists some of the occupations associated with increased risk of certain infections.1

Table 212-1 Occupational Skin Infections

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Table 212-1 Occupational Skin Infections

Occupational Groups at Risk137

Infections

Agricultural workers, farmers, shepherds, cattle workers, ranchers, animal scientists, animal breeders, veterinarians

Orf, milker's nodules, tinea barbae dermatophyte infections, mycetoma, chromoblastomycosis, sporotrichosis, cutaneous larva migrans

Athletes (wrestlers, surfers, swimmers, football, hockey and beach volleyball players, triatheletes)

Herpes gladiatorum, tinea corporis gladiatorum, impetigo, furunculosis, seabather's eruption, swimming pool granuloma (M. marinum), pseudomonas (“hot tub”) folliculitis, acne mechanica, cutanea larva migrans

Butchers, meat handlers, abattoir workers138

Staphylococcal and streptococcal infections, cutaneous anthrax, viral warts, erysipeloid, tularemia, brucellosis, leptospirosis

Construction and other outdoor workers

Blastomycosis, coccidioidomycosis, arthropod bites

Cooks, bakers, food handlers, dishwashers, cannery workers, bartenders, others doing wet work

Candidal intertrigo, paronychia, pseudomonas folliculitis

Fish merchants and fishermen

Staphylococcal, streptococcal infections, erysipeloid, vibrio vulnificus, aeromonas hydrophilia

Foresters, hunters

Tularemia, Lyme disease

Gardeners

Sporotrichosis

Hairdressers, manicurists

Staphylococcal and streptococcal infections

Healthcare workers (physicians, nurses, dentists, physician and dental assistants, respiratory therapists, paramedics)

Herpes simplex (herpetic whitlow), HIV infection, hepatitis, staphylococcal and streptococcal infections, candidiasis

Laboratory workers

Brucellosis, tularemia, HIV infection, hepatitis, monkeypox

Military personnel

Staphylococcal and streptococcal infections, dermatophyte infections, arthropod bites, leishmaniasis

Pet shop workers, aquarium handlers, fish tank cleaners

Fish tank granuloma (Mycobacterium marinum), monkeypox

Veterinarians

Cutaneous tuberculosis, cutaneous anthrax, brucellosis, tularemia, orf

See references 1–27.

HIV = human immunodeficiency virus.

Establishing a definite relationship between work and a specific infection is not always simple. Laboratory isolation of the infective organism and a supporting medical history and physical examination are helpful.

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